Individual
SHIJU M SIMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA-C
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-1000
Mailing address
362 GRASSMEADE WAY, SNELLVILLE, GA 30078-7782
(404) 271-7507
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
9220
GA
367H00000X
Anesthesiologist Assistant
AA287
FL
367H00000X
Anesthesiologist Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015893200
—
FL
Enumeration date
08/26/2015
Last updated
03/22/2023
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